| NPI | 1962836601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV RN75034) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 671057) |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2013-08-29 |